Administrators not fans of P4P, study finds

Nursing home administrators do not think highly of pay-for-performance (P4P) initiatives, with many not believing that they will increase revenues or improve quality, according to a study published online in the Journal of Aging and Social Policy.

Nicholas G. Castle, PhD, and colleagues from the University of Pittsburgh Graduate School of Public Health, the RAND Corp., and the University of Pittsburgh Medical Center Health Plan surveyed more than 2,400 nursing home administrators by mail. Most said they believed that P4P initiatives were designed to reduce costs rather than improve quality.

The researchers write that they hope the study will help in the design of future P4P systems.

Research published in August in Health Services Research noted that studies supporting the use of P4P are few and offer mixed results. The investigators examined the implementation of P4P by Medicaid in nursing homes in eight states and found that it did not lead to consistent improvements in quality. “Expectations for improvement in nursing home care under P4P should be tempered,” they wrote.

A 2009 review of studies published from 1980 to 2007 also said that “information on the impact of [P4P] programs is lacking in the nursing home setting.” The authors found 13 examples of P4P use in nursing homes, but “the programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare,” they said, writing in Health Care Financing Review.